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Ryu H, Shin KH, Chang JH, Jang BS. A nationwide study of breast reconstruction after mastectomy in patients with breast cancer receiving postmastectomy radiotherapy: comparison of complications according to radiotherapy fractionation and reconstruction procedures. Br J Cancer 2024; 131:290-298. [PMID: 38840031 PMCID: PMC11263609 DOI: 10.1038/s41416-024-02741-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND We examined the patterns of breast reconstruction postmastectomy in breast cancer patients undergoing postmastectomy radiotherapy (PMRT) and compared complications based on radiotherapy fractionation and reconstruction procedures. METHODS Using National Health Insurance Service (NHIS) data (2015-2020), we analysed 4669 breast cancer patients with PMRT and reconstruction. Using propensity matching, cohorts for hypofractionated fractionation (HF) and conventional fractionation (CF) were created, adjusting for relevant factors and identifying grade ≥3 complications. RESULT Of 4,669 patients, 30.6% underwent HF and 69.4% CF. The use of HF has increased from 19.4% in 2015 to 41.0% in 2020. Immediate autologous (32.9%) and delayed two-stage implant reconstruction (33.9%) were common. Complication rates for immediate (N = 1286) and delayed two-stage (N = 784) reconstruction were similar between HF and CF groups (5.1% vs. 5.4%, P = 0.803, and 10.5% vs. 10.7%, P = 0.856, respectively) with median follow-ups of 2.5 and 2.6 years. HF showed no increased risk of complications across reconstruction methods. CONCLUSION A nationwide cohort study revealed no significant difference in complication rates between the HF and CF groups, indicating HF for reconstructed breasts is comparable to CF. However, consultation regarding the fractionation for reconstructed breast cancer patients may still be necessary.
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Affiliation(s)
- Hyejo Ryu
- Department of Radiation Oncology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
- Department of Radiation Oncology, College of Medicine, Seoul National University, Seoul, Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, College of Medicine, Seoul National University, Seoul, Korea
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
| | - Ji Hyun Chang
- Department of Radiation Oncology, College of Medicine, Seoul National University, Seoul, Korea
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Bum-Sup Jang
- Department of Radiation Oncology, College of Medicine, Seoul National University, Seoul, Korea.
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.
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Saadatmand P, Mahdavi SR, Nikoofar A, Jazaeri SZ, Ramandi FL, Esmaili G, Vejdani S. A dosiomics model for prediction of radiation-induced acute skin toxicity in breast cancer patients: machine learning-based study for a closed bore linac. Eur J Med Res 2024; 29:282. [PMID: 38735974 PMCID: PMC11089719 DOI: 10.1186/s40001-024-01855-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/23/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Radiation induced acute skin toxicity (AST) is considered as a common side effect of breast radiation therapy. The goal of this study was to design dosiomics-based machine learning (ML) models for prediction of AST, to enable creating optimized treatment plans for high-risk individuals. METHODS Dosiomics features extracted using Pyradiomics tool (v3.0.1), along with treatment plan-derived dose volume histograms (DVHs), and patient-specific treatment-related (PTR) data of breast cancer patients were used for modeling. Clinical scoring was done using the Common Terminology Criteria for Adverse Events (CTCAE) V4.0 criteria for skin-specific symptoms. The 52 breast cancer patients were grouped into AST 2 + (CTCAE ≥ 2) and AST 2 - (CTCAE < 2) toxicity grades to facilitate AST modeling. They were randomly divided into training (70%) and testing (30%) cohorts. Multiple prediction models were assessed through multivariate analysis, incorporating different combinations of feature groups (dosiomics, DVH, and PTR) individually and collectively. In total, seven unique combinations, along with seven classification algorithms, were considered after feature selection. The performance of each model was evaluated on the test group using the area under the receiver operating characteristic curve (AUC) and f1-score. Accuracy, precision, and recall of each model were also studied. Statistical analysis involved features differences between AST 2 - and AST 2 + groups and cutoff value calculations. RESULTS Results showed that 44% of the patients developed AST 2 + after Tomotherapy. The dosiomics (DOS) model, developed using dosiomics features, exhibited a noteworthy improvement in AUC (up to 0.78), when spatial information is preserved in the dose distribution, compared to DVH features (up to 0.71). Furthermore, a baseline ML model created using only PTR features for comparison with DOS models showed the significance of dosiomics in early AST prediction. By employing the Extra Tree (ET) classifiers, the DOS + DVH + PTR model achieved a statistically significant improved performance in terms of AUC (0.83; 95% CI 0.71-0.90), accuracy (0.70), precision (0.74) and sensitivity (0.72) compared to other models. CONCLUSIONS This study confirmed the benefit of dosiomics-based ML in the prediction of AST. However, the combination of dosiomics, DVH, and PTR yields significant improvement in AST prediction. The results of this study provide the opportunity for timely interventions to prevent the occurrence of radiation induced AST.
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Affiliation(s)
- Pegah Saadatmand
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seied Rabi Mahdavi
- Department of Medical Physics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
- Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Alireza Nikoofar
- Department of Radiation Oncology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyede Zohreh Jazaeri
- Department of Neuroscience, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
- Division of NeuroscienceCellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Soheil Vejdani
- Department of Radiation Oncology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Radiation Oncology, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
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Marta GN, Moraes FY, de Oliveira Franco RC, de Andrade Carvalho H, Gouveia AG, de Lima Gössling GC, de Jesus RG, Ferraris G, Schuffenegger PM, Bardales GS, Chacón MAP, Murillo R, Sánchez LEM, Gamarra-Cabezas E, Rosa AA, da Silva MF, de Mattos MD, Morais DCR, de Castro DG, Dal Pra A, Amêndola BE, Barros JM, Lara TM, Isa N, de la Mata Moya D, Hidalgo I, Velilla DG, Loayza LEA, Montenegro FG, Sanchez Chacin NO, Werutsky G, Viani GA. Moderately hypofractionated post-operative radiation therapy for breast cancer: preferences amongst radiation oncologists from countries in Latin America and the Caribbean. Rep Pract Oncol Radiother 2023; 28:340-351. [PMID: 37795395 PMCID: PMC10547413 DOI: 10.5603/rpor.a2023.0046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/27/2023] [Indexed: 10/06/2023] Open
Abstract
Background The safety and effectiveness of moderately hypofractionated post-operative radiation therapy for breast cancer were demonstrated by several trials. This study aimed to evaluate the current patterns of practice and prescription preference about moderately hypofractionated post-operative radiation therapy to assess possible aspects that affect the decision-making process regarding the use of fractionation in breast cancer patients in Latin America and the Caribbean (LAC). We also aimed to identify factors that can restrain the utilization of moderately hypofractionated post-operative radiation therapy for breast cancer. Materials an methods Radiation oncologists from LAC were invited to contribute to this study. A 38-question survey was used to evaluate their opinions. Results A total of 173 radiation oncologists from 13 countries answered the questionnaire. The majority of respondents (84.9%) preferred moderately hypofractionated post-operative radiation therapy as their first choice in cases of whole breast irradiation. Whole breast plus regional nodal irradiation, post-mastectomy (chest wall and regional nodal irradiation) without reconstruction, and post-mastectomy (chest wall and regional node irradiation) with reconstruction hypofractionated post-operative radiation therapy was preferred by 72.2% 71.1%, and 53.7% of respondents, respectively. Breast cancer stage, and flap-based breast reconstruction were the factors associated with absolute contraindications for the use of hypofractionated schedules. Conclusion Even though moderately hypofractionated post-operative radiation therapy for breast cancer is considered a new standard to the vast majority of the patients, its unrestricted application in clinical practice across LAC still faces reluctance.
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Affiliation(s)
- Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
- Latin American Cooperative Oncology Group (LACOG), Brazil
| | - Fabio Y. Moraes
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Department of Oncology, Division of Radiation Oncology, Queen’s University — Kingston Health Science Centre, Kingston, ON, Canada
| | | | - Heloísa de Andrade Carvalho
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Department of Radiology and Oncology — Radiotherapy Division — Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - André Guimaraes Gouveia
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Juravinski Cancer Centre, Department of Oncology, Division of Radiation Oncology, Hamilton, ON, Canada
| | | | | | | | - Pablo Munoz Schuffenegger
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Radiation Oncology Unit, Department of Hematology — Oncology, Pontificia Universidad Catolica de Chile, Chile
| | | | | | - Raúl Murillo
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogota, Colombia
- Facultad de Medicina, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Luis Ernesto Moreno Sánchez
- Instituto Nacional del Cáncer Rosa De Tavares (INCART), Savia Care Centro Avanzado de Radioterapia, Centro Gamma Knife Dominicano, Dominican Republic
| | - Elizabeth Gamarra-Cabezas
- Departamento de Radio-Oncología, Instituto Oncológico Nacional “Dr. Juan Tanca Marengo”
- Sociedad de Lucha Contra el Cáncer (SOLCA), Guayaquil, Ecuador
| | - Arthur Accioly Rosa
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Oncoclinicas Salvador — Hospital Santa Izabel
| | - Maurício Fraga da Silva
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Santa Maria Federal University, Santa Maria, RS, Brazil
- Clínica de Radioterapia de Santa Maria, RS, Brazil
| | | | - Diego Chaves Rezende Morais
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Oncoclinicas Recife and Hospital Santa Águeda, Brazil
| | - Douglas Guedes de Castro
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Department of Radiation Oncology, A.C. Camargo Cancer Center, Brazil
| | - Alan Dal Pra
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Department of Radiation Oncology, University of Miami Miller School of Medicine, United States
| | | | - José Máximo Barros
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Departamento de Radio-Oncología, Instituto Oncológico Nacional “Dr. Juan Tanca Marengo”
- Centro de Radioterapia del Hospital Universitario Austral, Argentina
| | - Tomas Merino Lara
- Department of Hematology Oncology, school of Medicine, Pontificia Universidad Catolica de Chile, Chile
| | | | - Dolores de la Mata Moya
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Cancer Center — ABC Medical Center, Mexico
| | - Iván Hidalgo
- Centro Javeriano de Oncología — Hospital Universitario San Ignacio, Colombia
| | | | | | | | | | | | - Gustavo Arruda Viani
- Latin American Cooperative Oncology Group (LACOG), Brazil
- Ribeirão Preto Medical School, Department of Medical Imagings, Hematology and Oncology of University of São Paulo (FMRP-USP), Brazil
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Degrande FAM, Marta GN, Alves TMMT, Ferreira GBS, Dumaszak FV, Carvalho HA, Hanna SA. Deep inspiration breath hold: dosimetric benefits to decrease cardiac dose during postoperative radiation therapy for breast cancer patients. Rep Pract Oncol Radiother 2023; 28:172-180. [PMID: 37456706 PMCID: PMC10348328 DOI: 10.5603/rpor.a2023.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/23/2023] [Indexed: 07/18/2023] Open
Abstract
Background Postoperative radiation therapy (RT) is the standard treatment for almost all patients diagnosed with breast cancer. Even with modern RT techniques, parts of the heart may still receive higher doses than those recommended by clinically validated dose limit restrictions, especially when the left breast is irradiated. Deep inspiration breath hold (DIBH) may reduce irradiated cardiac volume compared to free breathing (FB) treatment. This study aimed to evaluate the dosimetric impact on the heart and left anterior descending coronary artery (LAD) in FB and DIBH RT planning in patients with left breast cancer. Materials and methods A retrospective cohort study of women diagnosed with left-sided breast cancer submitted to breast surgery followed by postoperative RT from 2015 to 2019. All patients were planned with FB and DIBH and hypofractionated dose prescription (40.05 Gy in 15 fractions). Results 68 patients were included in the study. For the coverage of the planned target volume evaluation [planning target volume (PTV) eval] there was no significant difference between the DIBH versus FB planning. For the heart and LAD parameters, all constraints evaluated favored DIBH planning, with statistical significance. Regarding the heart, median V16.8 Gy was 2.56% in FB vs. 0% in DIBH (p < 0.001); median V8.8 Gy was 3.47% in FB vs. 0% in DIBH (p < 0.001) and the median of mean heart dose was 1.97 Gy in FB vs. 0.92 Gy in DIBH (p < 0.001). For the LAD constraints D2% < 42 Gy, the median dose was 34.87 Gy in FB versus 5.8 Gy in DIBH (p < 0.001); V16.8 Gy < 10%, the median was 15.87% in FB versus 0% in DIBH (p < 0.001) and the median of mean LAD dose was 8.13Gy in FB versus 2.92Gy in DIBH (p < 0.001). Conclusions The DIBH technique has consistently demonstrated a significant dose reduction in the heart and LAD in all evaluated constraints, while keeping the same dose coverage in the PTV eval.
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Affiliation(s)
| | | | | | | | | | - Heloisa A. Carvalho
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
- Department of Radiotherapy, Universidade de São Paulo Instituto de Radiologia, Sao Paulo, Brazil
| | - Samir A. Hanna
- Department of Radiation Oncology, Hospital Sírio-Libanês, Sao Paulo, Brazil
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